Ann Surg Treat Res.  2023 Oct;105(4):219-227. 10.4174/astr.2023.105.4.219.

Upper thigh skeletal muscle index predicts outcomes in liver transplant recipients

• Lim M
• Kim JM
• Yang J
• Kwon J
• Kim KD
• Jeong ES
• Rhu J
• Choi GS
• Joh JW
• Lee SK

• KMID: 2546784
• DOI: http://doi.org/10.4174/astr.2023.105.4.219

Abstract

Purpose
The skeletal muscle index (SMI) at the L3 level is widely used to diagnose sarcopenia. The upper thigh (UT) also reflects changes in whole-body muscle mass, but no study has examined this using the UT to diagnose sarcopenia in liver transplantation (LT). This study aimed to determine an optimal cut-off value for UT-SMI and investigate how sarcopenia diagnosed by UT-SMI correlates with outcomes in LT recipients.
Methods
In this retrospective study of 332 LT patients from 2018 to 2020, we investigated the association between sarcopenia diagnosed by UT-SMI and patient outcomes after LT.
Results
The cut-off values for UT-SMI were 38.3 cm 2 /m 2 for females (area under the curve [AUC], 0.927; P < 0.001) and 46.7 cm 2 /m 2 for males (AUC, 0.898; P < 0.001). The prevalence of sarcopenia diagnosed by UT-SMI was 33.4% in our cohort. Patient and graft survival rates in the UT-SMI sarcopenia group were significantly poorer than those in the UT-SMI non-sarcopenia group (P < 0.001 and P < 0.001). UT-SMI was an independent prognostic factor for patient survival (hazard ratio [HR], 2.182; 95% confidence interval [CI], 1.183–4.025; P = 0.012) and graft survival (HR, 2.227; 95% CI, 1.054–4704; P = 0.036) in our multivariable Cox analysis.
Conclusion
We confirmed that sarcopenia diagnosed by UT-SMI is associated with outcomes in LT recipients. In addition, UT-SMI was identified as an independent prognostic factor for patient survival and graft survival. Therefore, UT-SMI could be a good option for CT-based evaluations of sarcopenia in LT recipients.

Keyword

Liver transplantation; Sarcopenia; Skeletal muscle; Thigh

Figure

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  Fig. 1 Overview of the study population.

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  Fig. 2 Scatterplot between L3-SMI and UT-SMI values in females (A) and males (B).

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  Fig. 3 The receiver operating characteristic curve analysis to find the optimal cut-off value for UT-SMI from the L3-SMI value in females (A) and males (B). AUC, area under the curve.

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  Fig. 4 Kaplan-Meier curves for patient survival (A) and graft survival (B) after liver transplantation in the sarcopenia group and non-sarcopenia group diagnosed by the upper thigh skeletal muscle index.

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